Category: Statistics

Sci Total Environ. 2023 Apr 25:163713. doi: 10.1016/j.scitotenv.2023.163713. Online ahead of print.

ABSTRACT

The water quality of a waterbody is determined by internal hydrodynamic processes as well as external loadings. Understanding the interaction between the external loading and internal process of a waterbody is essential for efficient water management and water quality improvement. Studies and efforts have focused on water and nutrient loading from drainage watersheds, but the contribution of the waterbody’s internal process to water quality is often ignored and not well documented. This study investigated how the water quality of Lake Okeechobee is controlled by external and internal factors using statistical and numerical modeling approaches. Water quantity and quality observed at the outlets of the Lake Okeechobee drainage basins and 19 monitoring sites located within the lake were statistically analyzed using multilinear regression. A three-dimensional numerical model, namely Environmental Fluid Dynamics Code (EFDC), was calibrated to the observations to mathematically represent the lake’s internal hydrodynamic process. The multilinear regression found that the water quality was the most sensitive to air temperature, the total phosphorus (TP) concentration of inflow entering the lake from the Kissimmee River basins, and the amount of outflow discharged from the lake among external factors. However, the regression models and their explanatory power were substantially varied by the monitoring stations. The model parameter sensitivity analysis of the calibrated EFDC model showed that model parameters related to the lake’s internal algal processes including algal growth, predation, and basal metabolism rates had greater impacts on algal biomass than other model parameters controlling nutrient-related processes such as nutrient half-saturation and hydrolysis rates. The EFDC input data sensitivity analysis found that wind (speed) is the major driving force for the internal hydrodynamic processes; its impact on algal biomass was greater than those of the external loadings. In addition, the algal biomass was found to have an inverse relationship with wind-induced horizontal currents. The results demonstrate the dynamic contribution of the internal and external drivers to the water quality of Lake Okeechobee, suggesting the need to consider both internal hydrodynamic and external loading processes for efficient water quality improvement of the lake.

PMID:37105475 | DOI:10.1016/j.scitotenv.2023.163713

J Affect Disord. 2023 Apr 25:S0165-0327(23)00534-7. doi: 10.1016/j.jad.2023.04.074. Online ahead of print.

ABSTRACT

BACKGROUND: Depression is a common and complex mental disease, and its pathogenesis involves several brain regions. Abnormalities in the amygdala-hippocampal neural circuits have been shown to be involved in depression. However, the underlying molecular mechanisms remain unclear.

METHODS: A rat model was used to determine the transcriptome changes in the amygdala-hippocampal neural network under chronic unpredictable mild stress (CUMS). Depression-related modules in this neural network were identified using weighted gene co-expression network analysis (WGCNA). Difference and enrichment analyses were used to determine differential gene expression in the two brain regions.

RESULTS: The modules in the amygdala and hippocampus associated with depression-like behavior contained 363 and 225 genes, respectively. Forty-two differentially expressed genes were identified in the amygdala candidate module and 37 in the hippocampus. Enrichment analysis showed that candidate genes in the amygdala were associated with neuronal myelination and candidate genes in the hippocampus were associated with synaptic transmission. Finally, based on module hub gene statistics, differential gene expression, and protein-protein interaction networks, 11 central genes were found in the amygdala candidate module, and one central gene was found in the hippocampal module.

LIMITATIONS: Our study was based on a rat CUMS model. Further evidence is needed to prove that our results are applicable to patients with depression.

CONCLUSION: This study identified critical modules and central genes involved in the amygdala-hippocampal circuit in the context of depression, and may provide further understanding of the pathogenesis of depression and help identify potential targets for antidepressant therapy.

PMID:37105469 | DOI:10.1016/j.jad.2023.04.074

J Acad Nutr Diet. 2023 Apr 25:S2212-2672(23)00220-4. doi: 10.1016/j.jand.2023.04.007. Online ahead of print.

NO ABSTRACT

PMID:37105445 | DOI:10.1016/j.jand.2023.04.007

Oncologist. 2023 Apr 27:oyad108. doi: 10.1093/oncolo/oyad108. Online ahead of print.

ABSTRACT

INTRODUCTION: To date, the role of deficient mismatch repair (dMMR) remains to be proven in gastric cancer, and it is difficult to judge its value in clinical application. Our study aimed to investigate how MMR status affected the prognosis in patients with gastrectomy, as well as the efficacy of neoadjuvant chemotherapy and adjuvant chemotherapy in patients with dMMR with gastric cancer.

MATERIALS AND METHODS: Patients with gastric cancer with certain pathologic diagnosis of dMMR or proficient MMR (pMMR) using immunohistochemistry from 4 high-volume hospitals in China were included. Propensity score matching was used to match patients with dMMR or pMMR in 1:2 ratios. Overall survival (OS) and progression-free survival (PFS) curves were plotted using the Kaplan-Meier method and compared statistically using the log-rank test. Univariate and multivariate Cox proportional hazards models based on hazard ratios (HRs) and 95% confidence intervals (CIs) were used to determine the risk factors for survival.

RESULTS: In total, data from 6176 patients with gastric cancer were ultimately analyzed, and loss of expression of one or more MMR proteins was observed in 293 patients (293/6176, 4.74%). Compared to patients with pMMR, patients with dMMR are more likely to be older (≥66, 45.70% vs. 27.94%, P < .001), distal location (83.51% vs. 64.19%, P < .001), intestinal type (42.21% vs. 34.46%, P < .001), and in the earlier pTNM stage (pTNM I, 32.79% vs. 29.09%, P = .009). Patients with gastric cancer with dMMR showed better OS than those with pMMR before PSM (P = .002); however, this survival advantage was not observed for patients with dMMR after PSM (P = .467). As for perioperative chemotherapy, results of multivariable Cox regression analysis showed that perioperative chemotherapy was not an independent prognostic factor for PFS and OS in patients with dMMR with gastric cancer (HR = 0.558, 95% CI, 0.270-1.152, P = .186 and HR = 0.912, 95% CI, 0.464-1.793, P = .822, respectively).

CONCLUSION: In conclusion, perioperative chemotherapy could not prolong the OS and PFS of patients with dMMR with gastric cancer.

PMID:37104872 | DOI:10.1093/oncolo/oyad108

Med Educ Online. 2023 Dec;28(1):2207249. doi: 10.1080/10872981.2023.2207249.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic diminished opportunities for medical students to gain clinical confidence and the ability to contribute to patient care. Our study sought out to understand the value of telephone outreach to schedule COVID-19 vaccines on medical student education.

MATERIALS AND METHODS: Forty students engaged in telephone outreach targeting patients aged 65+ without active patient portals to schedule COVID-19 vaccines. Data consisted of a single administration retrospective pre/post survey inquiring about what students learned, expectations, other health-care processes that would benefit from outreach, and interest in a population health elective. Likert items were analyzed and open response analysis involved inductive coding and generation of thematic summaries by condensing codes into broader themes. Demographic data of patients called and subsequently received the vaccine were also collected.

RESULTS: There were 33 survery respondents. There was a statistically significant increase in net comfortability for pre-clerkship students for documenting in Epic, providing telehealth care, counseling on common health-care myths, having challenging conversations, cold-calling patients, and developing an initial trusting relationship with patients. The majority called and who received the vaccine were non-Hispanic Black, within the high SVI category, and had Medicare and/or Medicaid. Qualitative data showed that students emphasized communication, the role of trusted messengers, the need to be open minded, and meeting patients where they are.

DISCUSSION: Engaging students in telephone outreach early in the COVID-19 pandemic provided students the opportunity to develop their skills as physicians-in-training, contribute to combating the ongoing pandemic, and add value to the primary care team. This experience allowed students to practice patience, empathy, and vulnerability to understand why patients had not received the COVID-19 vaccine; this was an invaluable experience that helped students develop the skills to become empathetic and caring physicians, and supports the continued role of telehealth in future medical school curriculum.

PMID:37104856 | DOI:10.1080/10872981.2023.2207249

Am J Manag Care. 2023 Apr 1;29(4):e124-e128. doi: 10.37765/ajmc.2023.89353.

ABSTRACT

OBJECTIVES: We aimed to describe the experience of a state Medicaid agency incentivizing reduction of racial and ethnic disparities in a hospital quality incentive program (QIP).

STUDY DESIGN: Retrospective review of a decade of experience implementing a hospital health disparity (HD) composite measure.

METHODS: Observational analysis of programwide trends in missed opportunity rates and between-group variance (BGV) for the HD composite from 2011 to 2020 and subanalysis of 16 metrics included in the HD composite for at least 4 years over the decade.

RESULTS: Programwide missed opportunity rates and BGV fluctuated widely from 2011 to 2020, likely due to variation in measures included in the HD composite. When the 16 measures that were included in the HD composite for at least 4 years were collapsed into a hypothetical 4-year period, missed opportunity rates decreased across the 4 consecutive years, from 47% in year 1 to 20% in year 4. Differences among racial and ethnic subgroups also decreased across the 4-year period, as reflected in the BGV decrease from 7.85 × 10-4 in year 1 to 5.10 × 10-4 in year 4.

CONCLUSIONS: Construction of a composite measure, use of a summary disparity statistic, and measure selection are key considerations in the design and interpretation of equity-focused payment programs. This analysis revealed improved aggregate quality performance and a modest reduction in racial and ethnic disparities for measures included in the HD composite for at least 4 years. Further research is needed to evaluate the association between equity-oriented incentives and health disparities.

PMID:37104839 | DOI:10.37765/ajmc.2023.89353

Am J Manag Care. 2023 Apr 1;29(4):e117-e123. doi: 10.37765/ajmc.2023.89352.

ABSTRACT

OBJECTIVES: To determine whether broad categories of criteria exist among prior authorization (PA) policies from different managed care organizations (MCOs) and to identify similarities and differences among MCO coverage requirements for medications within the calcitonin gene-related peptide (CGRP) antagonist class.

STUDY DESIGN: Quantitative and qualitative descriptive analysis.

METHODS: PA policies from different MCOs for erenumab, fremanezumab, galcanezumab, and eptinezumab were identified through a comprehensive online search. Individual criteria from each policy were analyzed and grouped into both broad and specific categories. Descriptive statistics were used to identify and summarize trends among policies.

RESULTS: A total of 47 MCOs were included in the analysis. The vast majority of policies applied to galcanezumab (n = 45; 96%), erenumab (n = 44; 94%), and fremanezumab (n = 40; 85%), with fewer policies for eptinezumab (n = 11; 23%). There were 5 broad categories of PA criteria found to be included in coverage policies: prescriber specialization (n = 21; 45%), prerequisite drugs (n = 45; 96%), safety considerations (n = 8; 17%), and response to therapy (n = 43; 91%). The final category, titled appropriate use, included any criteria meant to ensure appropriate medication use and included age requirements (n = 26; 55%), suitable diagnosis (n = 34; 72%), exclusion of other diagnoses (n = 17; 36%), and exclusion of concurrent medications (n = 22; 47%).

CONCLUSIONS: This study identified 5 broad categories of PA criteria used by MCOs in the management of CGRP antagonists. However, within these categories, specific criteria from different MCOs varied significantly.

PMID:37104838 | DOI:10.37765/ajmc.2023.89352

J Exp Psychol Gen. 2023 Apr 27. doi: 10.1037/xge0001357. Online ahead of print.

ABSTRACT

Researchers often remove outliers when comparing groups. It is well documented that the common practice of removing outliers within groups leads to inflated Type I error rates. However, it was recently argued by André (2022) that if outliers are instead removed across groups, Type I error rates are not inflated. The same study discusses that removing outliers across groups is a specific case of the more general concept of hypothesis-blind removal of outliers, which is consequently recommended. In this paper, I demonstrate that, contrary to this advice, hypothesis-blind outlier removal is problematic. Specifically, it almost always invalidates confidence intervals and biases estimates if there are group differences. It moreover inflates Type I error rates in certain situations, for example, when variances are unequal and data nonnormal. Consequently, a data point may not be removed solely because it is deemed an outlier, whether the procedure used is hypothesis-blind or hypothesis-aware. I conclude by recommending valid alternatives. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37104797 | DOI:10.1037/xge0001357

Clin Orthop Relat Res. 2023 Apr 27. doi: 10.1097/CORR.0000000000002627. Online ahead of print.

ABSTRACT

BACKGROUND: The initial approach to the treatment of desmoid tumors has changed from surgical resection to watchful waiting. However, surgery is still sometimes considered for some patients, and it is likely that a few patients would benefit from tumor removal if the likelihood of local recurrence could be predicted. However, to our knowledge, there is no tool that can provide guidance on this for clinicians at the point of care.

QUESTION/PURPOSE: We sought to explore whether a combined molecular and clinical prognostic model for relapse in patients with desmoid tumors treated with surgery would allow us to identify patients who might do well with surgical excision.

METHODS: This was a retrospective, single-center study of 107 patients with desmoid tumors who were surgically treated between January 1980 and December 2015, with a median follow-up of 106 months (range 7 to 337 months). We correlated clinical variables (age, tumor size, and localization) and CTNNB1 gene mutations with recurrence-free survival. Recurrence-free survival was estimated using a Kaplan-Meier curve. Univariate and multivariable analyses of time to local recurrence were performed using Cox regression models. A final nomogram model was constructed according to the final fitted Cox model. The predictive performance of the model was evaluated using measures of calibration and discrimination: calibration plot and the Harrell C-statistic, also known as the concordance index, in which values near 0.5 represent a random prediction and values near 1 represent the best model predictions.

RESULTS: The multivariable analysis showed that S45F mutations (hazard ratio 5.25 [95% confidence interval 2.27 to 12.15]; p < 0.001) and tumor in the extremities (HR 3.15 [95% CI 1.35 to 7.33]; p = 0.008) were associated with a higher risk of local recurrence. Based on these risk factors, we created a model; we observed that patients considered to be at high risk of local recurrence as defined by having one or two factors associated with recurrence (extremity tumors and S45F mutation) had an HR of 8.4 compared with patients who had no such factors (95% CI 2.84 to 24.6; p < 0.001). From these data and based on the multivariable Cox models, we also developed a nomogram to estimate the individual risk of relapse after surgical resection. The model had a concordance index of 0.75, or moderate discrimination.

CONCLUSION: CTNNB1 S45F mutations combined with other clinical variables are a potential prognostic biomarker associated with the risk of relapse in patients with desmoid tumors. The developed nomogram is simple to use and, if validated, could be incorporated into clinical practice to identify patients at high risk of relapse among patients opting for surgical excision and thus help clinicians and patients in decision-making. A large multicenter study is necessary to validate our model and explore its applicability.

LEVEL OF EVIDENCE: Level III, therapeutic study.

PMID:37104792 | DOI:10.1097/CORR.0000000000002627

J Pediatr Orthop. 2023 Apr 27. doi: 10.1097/BPO.0000000000002420. Online ahead of print.

ABSTRACT

BACKGROUND: Patella alta is an anatomic risk factor for patellar instability in adolescents that is also linked to the risk factor of trochlear dysplasia. This study aims to determine the age of onset and age-related incidence of patella alta in a pediatric population of patients with patellar instability. We hypothesized that patellar height ratios would not increase with age, suggesting a congenital rather than the developmental origin of patella alta.

METHODS: A retrospective cross-sectional cohort of patients was collected with the following inclusion criteria: patients aged 5 to 18 who had a knee magnetic resonance imaging performed from 2000 to 2022 and the International Classification of Diseases code for patellar dislocation. Demographic information and details of the patellar instability episode(s) were collected with a chart review. Sagittal magnetic resonance imaging was used to measure Caton-Deschamps Index (CDI) and the Insall-Salvati Ratio (ISR) by 2 observers. Data were analyzed to assess for associations between patellar height ratios and age of the first dislocation and to assess if the proportion of patients categorized as having patella alta changed with age.

RESULTS: The 140 knees included in the cohort had an average age of 13.9 years (SD=2.40; range: 8-18) and were 55% female. Patella alta was present in 78 knees (55.7%) using CDI>=1.2 and in 59 knees (42.1%) using ISR>=1.3. The earliest age patella alta was observed was at age 8 using CDI>=1.2 and age 10 using ISR>=1.3. There were no statistically significant associations between CDI and age without adjustment (P=0.14) nor after adjustment for sex and body mass index (P=0.17). The proportion of knees above the CDI threshold for patella alta to the knees below the cutoff did not show a significant change with age (P=0.09).

CONCLUSIONS: Patella alta, as defined by CDI, is seen in patients as young as 8 years old. Patellar height ratios do not change with age in patients with patellar dislocation, suggesting that patella alta is established at a young age rather than developing during the adolescent years.

LEVEL OF EVIDENCE: Level III-diagnostic, cross-sectional.

PMID:37104788 | DOI:10.1097/BPO.0000000000002420